Pittsburgh-based UPMC will soon get another day in court to challenge a ruling that it must continue to provide in-network services to members of Highmark's Medicare Advantage plans.
The Pennsylvania Supreme Court agreed Tuesday to grant UPMC's request for an expedited argument in its appeal. Arguments before the state's high court are scheduled for Oct. 6—less than two weeks before the beginning of Medicare open enrollment.
A state judge ruled against UPMC in May, saying the system must remain an in-network provider for Highmark's Medicare Advantage plans through the term of a consent decree reached between the two feuding organizations last year. The decision came after the state took UPMC to court over its plans to end its Advantage contracts with Highmark because Highmark allegedly failed to pay UPMC contracted rates for cancer care.
In court documents, UPMC said the appeal should be heard quickly so it knows whether it may end its Medicare Advantage contracts with Highmark at the end of the year as originally planned.
The state of Pennsylvania, however, argued that there was no pressing need for a speedy appeal because it's already too late for the court to reverse the lower court's decision without causing major problems for consumers.
The state noted that the federal government is supposed to provide consumers with comparative information about Medicare plans by Sept. 30, and insurers must supply that information to the government by Aug. 25.
“A decision in UPMC's favor at that point would massively disrupt the Medicare process described above,” the state argued. “At best it would unleash chaos, as consumers scrambled to make sense of conflicting information, and identify their options, within the limited time that would then be available. At worst, it could leave some consumers—those who failed to hear about the court's decision or to appreciate its significance—marooned for another year in their current plan without effective access to hospital care.”
The state argued that even if the court were to ultimately agree with UPMC, a transition period would be necessary before UPMC could terminate its contracts with Highmark.
The decision may affect about 181,000 Highmark consumers.
Highmark and UPMC have been battling since Highmark, the largest health insurer in the region, acquired a competing health system—now called Allegheny Health Network—in 2013. A contract between them expired at the end of last year, and a transition plan approved by the Pennsylvania Insurance Department described which UPMC facilities and services would be in-network and out-of-network after the contract's expiration. That plan carries out the terms outlined in a consent decree signed in June.
